Original article
Epidemiology of Candida isolates from Intensive Care Units in Colombia from 2010 to 2013Epidemiología de aislamientos de Candida en unidades de cuidados intensivos en Colombia durante el período 2010–2013

https://doi.org/10.1016/j.riam.2016.02.006Get rights and content

Abstract

Background

The frequency of Candida isolates as a cause of hospital infections has risen in recent years, leading to high rates of morbidity and mortality. The knowledge of the epidemiology of those hospital acquired fungal infections is essential to implement an adequate antifungal therapy.

Aims

To describe the epidemiology of Candida infections in Intensive Care Units (ICUs) from a surveillance network in Colombia.

Methods

Information was collected from the microbiology laboratories of 20 tertiary healthcare institutions from 10 Colombian cities using the Whonet® software version 5.6. A general descriptive analysis of Candida species and susceptibility profiles focusing on fluconazole and voriconazole was completed between 2010 and 2013, including a sub-analysis of healthcare associated infections (HAIs) during the last year.

Results

Candida isolates made up 94.5% of the 2680 fungal isolates considered, with similar proportions for Candida albicans and non-C. albicans Candida species (48.3% and 51.7%, respectively). Among the latter, Candida tropicalis (38.6%) and Candida parapsilosis (28.5%) were the most frequent species. Of note, among the blood isolates C. albicans was not the main species. Most of the species isolated were susceptible to fluconazole and voriconazole. From the HAIs reported, 25.5% were caused by Candida; central line-associated bloodstream infection was the most common HAI (58.8%). There were no statistically significant differences regarding length of hospital stay and device days among HAIs.

Conclusions

In ICUs of Colombia, non-C. albicans Candida species are as frequent as C. albicans, except in blood samples where non-C. albicans Candida isolates predominate. Further studies are needed to evaluate Candida associated risk factors and to determine its clinical impact.

Resumen

Antecedentes

La frecuencia de aislamientos de Candida causantes de infecciones hospitalarias ha aumentado en los últimos años, lo que implica altas tasas de morbimortalidad. El conocimiento de la epidemiología de estas infecciones nosocomiales asociadas con hongos es indispensable para instaurar una terapia antifúngica adecuada.

Objetivos

Describir la epidemiologia de las infecciones causadas por Candida en las unidades de cuidados intensivos (UCI) de una red de vigilancia de Colombia.

Métodos

La información se recogió en los laboratorios de microbiología de 20 instituciones de tercer nivel en 10 ciudades de Colombia a través de Whonet® versión 5.6. Se realizó un análisis descriptivo general de las especies de Candida más frecuentes y de su perfil de sensibilidad al fluconazol y al voriconazol desde 2010 hasta 2013, incluyendo un subanálisis de las infecciones asociadas con la atención de salud (IAAS) durante el último año.

Resultados

De los 2.680 aislamientos de hongos, el 94,5% correspondió a especies de Candida, con proporciones similares entre Candida albicans y el resto de especies del género halladas (el 48,3 y el 51,7%, respectivamente). La mayor prevalencia entre estas últimas correspondió a Candida tropicalis (38,6%) y Candida parapsilosis (28,5%). En muestras de sangre, C. albicans no fue la especie más frecuente. La mayoría de especies fue sensible al fluconazol y al voriconazol. Candida causó el 25,5% de las IAAS reportadas, con la infección del torrente circulatorio asociada con catéter (58,8%) como la más frecuente de las patologías. No hubo diferencias estadísticamente significativas en el tiempo de estancia hospitalaria o en el de uso de cualquier eventual dispositivo entre las IAAS.

Conclusiones

En las UCI de Colombia, la prevalencia de C. albicans es muy similar al del resto de especies en conjunto. Únicamente en sangre fue evidente el predominio de otras especies del género diferentes de C. albicans. Otros estudios son necesarios para evaluar factores asociados con la infección por Candida y determinar su impacto en estos pacientes.

Section snippets

Participating institutions

Data from the clinical isolates of Candida collected in ICUs of 20 tertiary healthcare institutions (that belong to the National Bacterial Resistance and HAIs Surveillance Network) between January 1st, 2010 and December 31st, 2013 were analyzed. Hospitals from the following Colombian cities were included: Barranquilla, Bogotá, Bucaramanga, Cali, Cúcuta, Ibagué, Medellín, Neiva, Pasto and Pereira. Most hospitals were private (n = 14) and teaching hospitals (n = 15) catalogued as medium size

Results

Between 2010 and 2013, 44,438 microbiological isolates, including bacteria and fungi, were reported; 2680 (6%) corresponded to fungi. Out of these, 2533 (94.5%) belonged to Candida genus (Table 1). During the study period C. albicans and non-C. albicans Candida species had similar proportions (48.3% and 51.7% respectively) and did not present significant differences over time (p = 0.24/Wilcoxon Mann–Whitney test) (Fig. 1). The most prevalent species among the non-Calbicans Candida species were

Discussion

Fungal infections are challenging healthcare infections in critically-ill patients due to the difficulty in diagnosis and empirical management; these infections are usually associated with increased rates of morbidity and mortality. Candida species are the third most frequent cause of bloodstream infections in ICU50 and the main clinical presentation is invasive candidiasis (IC). Prolonged length of stay, presence of invasive devices, major burn injuries, hemodialysis, neutropenia, bone-marrow

Funding

This study was partially supported by research grants from Merck Sharp & Dohme (FC-000687-2012) and Pfizer S.A. (FC-000583-2012). Merck Sharp & Dohme., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (MSD) and Pfizer S.A. had no influence on designing and writing the protocol, the collection of the data, performing the analysis of the results, or the writing of the manuscript.

Conflict of interest

Dr. Christian Pallares is a speaker for Pfizer SA, Merck Colombia S.A. and Merck Sharp & Dohme. Dr. José Oñate is a speaker for Pfizer S.A. and Merck Colombia S.A. Cristhian Hernandez is speaker for Merck Sharp & Dohme. Dr. Villegas is a consultant or speaker for Merck Sharp & Dohme, Merck Colombia S.A. and Pfizer S.A., and received research grants for the conformation of the network from Merck Sharp & Dohme, Merck Colombia S.A. and Pfizer S.A.

The other authors declare no conflicts of interest

Acknowledgments

We thank the people from the participant institutions and hospitals (2010–2013): Bogotá (Guillermo Prada, Stella Vanegas, Adriana Merchan, Henry Mendoza, Francisco Ortiz, Marta Patricia Meléndez, Carlos Álvarez, Sandra Valderrama, Katherine Gómez, Carlos Pérez, Julián Escobar, Luz Ángela Pescador, Sandra Gualtero, Gerson Arias), Cali (Leonor Dicué, Sandra Ossa, Martín Muñoz, Fernando Rosso, Marly Orrego, Lorena Matta, Socorro Trujillo), Pereira (Carmen Elisa Llanos, Berenice Isaza), Pasto

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